3059 - Disparities in Diagnosis and Access to Care in Patients with Young-Onset Colorectal Cancers in Northeast Ohio

R. Patel¹, A. T. Price¹, E. Steinhagen², M. Conces³, J. A. Dorth¹, J. Miller-Ocuin², J. E. Selfridge³, A. Mohamed³, S. Chakrabarti³, A. Mahipal³, D. Bajor³, M. Lumish³, and L. E. Henke¹; ¹Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, ²Division of Colorectal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, ³Department of Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH

Purpose/Objective(s): The rise in young-onset colorectal cancers (YO-CRC) in individuals <50 is alarming. Despite updated USPSTF CRC screening guidelines, disparities in care for YO-CRC remains largely under addressed. We investigated modifiable disparities in patients with YO-CRC to be addressed with future interventions. Materials/

Methods: We analyzed patients with newly diagnosed YO-CRC from 2001-2023 at a Northeast Ohio academic center. Demographic information, residential poverty index (PI; low-PI = <15%, high-PI = =15%), and rural-urban zip codes were curated from Small Area Income and Poverty Estimates (SAIPE) and Rural-Urban Commuting Area Codes (RUCA) from US Census data. A retrospective review was completed to assess time from symptom onset to diagnosis. Access to guideline-concordant care was evaluated via clinic visits with specialty providers in medical oncology, radiation oncology, colorectal surgery, genetics, and onco-fertility. Chi-square and Cox regression analyses were conducted.
Results: In 116 patients with YO-CRC, 54% were female (n=63), 46% male (n=53), of which 74% were White (W, n=86), 26% were Non-White (NW, n=30), 44% were in low-PI (n=51), and 56% were in high-PI (n=65). Median age at diagnosis was 45 yrs (IQR[39-47]). Time from symptom onset to diagnosis was significantly longer in NW patients compared to W patients (mean 6.0mo vs 1.4mo, p<0.001), and in patients with high-PI compared to low-PI (mean 3.9mo vs 1.1mo, p<0.001). Colonoscopy rates after symptom onset at 2mo and 4mo were significantly decreased for NW vs W with 21% vs 68% and 36% vs 79% (p<0.001, respectively), and high-PI vs low-PI with 41% vs 71% (p=0.002) and 55% vs 79% (p=0.01). Access to specialty care after diagnosis was similar across groups, but there were significant delays in access to genetics in NW compared with W (15.5 mo vs 6.5 mo, p<0.001). The median 1-yr and 2-yr overall survival (OS) was 50.2% and 27.2% for NW patients vs 92.3% and 42.5% for W patients (p<0.001). On multivariate analysis, time from symptom onset to diagnosis was assessed for association, with HR <1 indicating longer time to diagnosis, seen with NW (HR=0.22, p<0.001) and high-PI (HR=0.50, p<0.004). Conversely, HR >1 were associated with shorter time to diagnosis, seen with increasing age at diagnosis (HR=1.03, p=0.03). Worse OS was associated with NW with a HR of 3.30 (CI­₉₅: 1.32-8.22, p=0.01), with suggestion of association for rural zip codes with a HR of 1.19 (CI₉₅: 1.00-1.41, p=0.051).
Conclusion: Our study revealed significantly prolonged time from symptom onset to diagnosis in NW patients with YO-CRC and those living in high-PI, potentially contributing to more advanced initial staging and reduced survival. Despite similar access to oncology care post-diagnosis, a notable disparity persists in timely use of genetic services. These findings highlight the need for targeted interventions to mitigate the impact of socioeconomic factors and racial factors to address disparities in diagnosis, access, and treatment of YO-CRC.